Coordinating systems of care using health information technology: development of the ADHD Care Assistant

Power, Thomas J.; Michel, Jeremy J.; Mayne, Stephanie L.; Miller, Jeffrey M.; Blum, Nathan J.; Grundmeier, Robert W.; Guevara, James P.; Fiks, Alexander G.

doi:10.1080/1754730x.2016.1199283

Cited by 25 publications

(31 citation statements)

References 34 publications

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“…An electronic health record portal promoted collaboration among parents of children with ADHD, teachers, and medical providers. The portal facilitated collection of parent and teacher information and incorporated it into the electronic health record, resulting in improved parent and teacher ratings of child ADHD symptoms …”

Section: Discussionmentioning

confidence: 99%

Educators' Perspectives of Collaboration With Pediatricians to Support Low‐Income Children

Lemkin

Walls

Kistin

et al. 2019

Journal of School Health

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BACKGROUND Educational and healthcare systems operate in silos. Few studies explore educators' perspectives of collaboration with pediatricians or cross‐system solutions for school‐identified concerns. We sought to investigate educators' viewpoints of collaboration with pediatricians. METHODS We conducted semistructured, qualitative interviews with full‐time teachers, vice‐principals, and principals, who worked with low‐income first‐ or second‐grade students. Interviews explored which students were concerning to educators, educators' experiences with collaboration, and barriers and facilitators of collaboration. Interview transcripts were analyzed with modified grounded theory. RESULTS We interviewed 12 teachers and 3 principals/vice‐principals. Students' socioemotional problems were a foremost concern. Effective collaboration with pediatricians was not typical. Participants described not knowing they could communicate with pediatricians or that collaboration was often limited or unidirectional. Respecting boundaries of parental privacy and maintaining parental trust emerged as potential barriers. Some participants described negative experiences with pediatricians and reflected on societal perceptions of doctors and teachers, which could affect the development of relationships. Participants recognized potential benefits to collaboration, including gaining a holistic understanding of a child's health and home life. CONCLUSIONS Educators perceived collaboration with pediatricians as inadequate. More developed and tested programs that foster collaboration between schools and pediatricians are needed to support low‐income youth.

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Section: Discussionmentioning

confidence: 99%

Educators' Perspectives of Collaboration With Pediatricians to Support Low‐Income Children

Lemkin

Walls

Kistin

et al. 2019

Journal of School Health

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“…Indeed, several quality improvement efforts, including some with empirical support, 4,9,11,31 exist that directly improve the quality of several components of ADHD care, including timeliness of initial visits and teacher-rating scale collection. 4 Many of these efforts offer technological innovations, some of which include electronic health record integration, 32 that facilitate parent- and teacher-rating scale collection 4,9,32 . Finally, primary care pediatricians should be incentivized to focus on components of ADHD care that lead to better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Specific Components of Pediatricians’ Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement

Epstein

Kelleher

Baum

et al. 2017

Journal of the American Academy of Child & Adolescent Psych

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Objective The development of attention-deficit/hyperactivity disorder (ADHD) care quality measures is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes. Method Parents of 372 medication-naïve children in grades 1-5 presenting to their community-based pediatrician (n = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and again approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure twelve different components of ADHD care. Results Across all children, the mean (SD) VAPRS Total Symptom Score (TSS) reduction over the first year of treatment was 11.6 (10.1). Of the twelve components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater reductions in patient TSS scores. Notably, it was timeliness of contacts, defined as either office visits, phone calls, or email communication, that predicted more ADHD symptom reduction. Office visits alone, in terms of number or timeliness, did not predict patient outcomes. Conclusion The magnitude of ADHD symptom reduction that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development/modifications of ADHD quality care metrics should include these ADHD care components.

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“…The Care Assistant sent electronic surveys via email to parents and teachers and presented results seamlessly in the EHR. 26 The Care Assistant was made available to all clinicians in the network, including those in the study and those who were not, prior to the intervention period. All providers were offered web-based training on how to use the Care Assistant and nearly all (100/105) completed training.…”

Section: Methodsmentioning

confidence: 99%

Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial

Fiks

Mayne

Michel

et al. 2017

J Dev Behav Pediatr

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Objective To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of ADHD rating scales. Method Primary care practices were cluster-randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record-linked system for gathering ADHD rating scales from parents and teachers was implemented prior to the intervention period at all sites. Rating scale use was ascertained by manual chart review. Results 105 clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and following implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least one feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval: 0.6, 27.7) and 18.8 (95% confidence interval: 1.9, 35.7) percentage points, respectively. Conclusion A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal.

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Coordinating systems of care using health information technology: development of the ADHD Care Assistant

Cited by 25 publications

References 34 publications

Educators' Perspectives of Collaboration With Pediatricians to Support Low‐Income Children

Educators' Perspectives of Collaboration With Pediatricians to Support Low‐Income Children

Specific Components of Pediatricians’ Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement

Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial

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